Music intervention lowers anxiety, sedation in ICU

Among ICU patients receiving acute ventilatory support for respiratory failure, use of patient-preferred music resulted in greater reduction in anxiety and sedation frequency and intensity compared with usual care, according to a study.

"Critically ill mechanically ventilated patients receive intravenous sedative and analgesic medications to reduce anxiety and promote comfort and ventilator synchrony," according to background information in the study, which was published May 20 on the website of the Journal of the American Medical Association and scheduled for presentation at the American Thoracic Society’s international conference in Philadelphia.

These potent medications often are administered at high doses for prolonged periods and are associated with various adverse effects. "Mechanically ventilated patients have little control over pharmacological interventions to reduce anxiety; dosing and frequency of sedative and analgesic medications are controlled by intensive care unit clinicians. Interventions are needed that reduce anxiety, actively involve patients and minimize the use of sedative medications."

The authors noted that "listening to preferred, relaxing music has reduced anxiety in mechanically ventilated patients in limited trials. It is not known if music can reduce anxiety throughout the course of ventilatory support, or reduce exposure to sedative medications."

Linda L. Chlan, RN, PhD, of Ohio State University, and colleagues conducted a study to evaluate whether a patient-directed music intervention could reduce anxiety and sedative exposure in ICU patients receiving mechanical ventilation. The clinical trial included 373 patients from 12 ICUs at five hospitals in the Minneapolis-St. Paul area who received acute mechanical ventilatory support for respiratory failure between September 2006 and March 2011.

Of the patients included in the study, 86% were white and 52% were female, and the average age was 59. Patients were randomized to self-initiated patient-directed music — with preferred selections tailored by a music therapist — whenever desired while receiving ventilatory support; self-initiated use of noise-canceling headphones; or usual care. The main outcomes examined were daily assessments of anxiety (on a 100-millimeter visual analog scale) and two aggregate measures of sedative exposure (intensity and frequency).

The music intervention patients listened to music for an average of 80 minutes a day; the patients with noise-canceling headphones wore the headphones for an average of 34 minutes a day.

Analysis showed that patients in the music intervention group had an anxiety score that was 19.5 points lower than patients in the usual care group. For an average patient on the fifth study day (the average time patients were enrolled), a usual care patient received five doses of any one of the eight study-defined sedative medications. An equivalent music intervention patient received three doses of sedative medications on the fifth day, a relative reduction of 38%. By the end of the fifth day, music intervention patients had a relative reduction of 36% in their sedation intensity scores and 36.5% in their anxiety scores.

Patient-directed music did not result in greater reduction in anxiety or sedation intensity compared with noise-canceling headphones, although it did reduce sedation frequency compared with headphone use.

"Music provides patients with a comforting and familiar stimulus and the PDM [patient-directed music] intervention empowers patients with their own anxiety management," the authors wrote. "It is an inexpensive, easily implemented nonpharmacological intervention that can reduce anxiety, reduce sedative medication exposure and potentially associated adverse effects. The PDM patients received less frequent and less intense sedative regimens while reporting decreased anxiety levels."

In an accompanying editorial, Elie Azoulay, MD, PhD, of the Universite Paris-Diderot, Sorbonne Paris-Cite, and colleagues wrote: "Reducing anxiety and amount of sedation in mechanically ventilated patients is of the utmost importance, particularly because the result may be a decrease in the post-ICU burden, which weighs heavily on many patients, as well as numerous complications related to sedation.

"The trial … provides preliminary data that create new possibilities for improving the well-being of ICU patients. Further studies are needed to better understand how music therapy might improve the ICU experience for critically ill patients."